Provider Demographics
NPI:1831410448
Name:PATEL, BHAVIN LALJIBHAI (PHARMACIST)
Entity type:Individual
Prefix:
First Name:BHAVIN
Middle Name:LALJIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 STEVENS ROAD, APT # 36
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057
Mailing Address - Country:US
Mailing Address - Phone:973-777-3143
Mailing Address - Fax:
Practice Address - Street 1:4 STEVENS RD APT 36
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-2750
Practice Address - Country:US
Practice Address - Phone:973-777-3143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054157-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist